Closing the chasm

A boy born in leafy Hampstead today can expect to live 11 years longer than a boy born a few miles away in St Pancras; boys born in parts of India will live longer than those born in parts of Glasgow. The nation's health keeps getting better, but the health gap between rich and poor keeps on getting worse. It is not that the government is doing nothing, but it may not be doing enough, or doing it in the right way.

Yesterday's report from the World Health Organisation brings a global dimension to the influence of social factors on health. It was the inspiration of Professor Sir Michael Marmot. It is because of his work that we know so much about how bad things are here; he also advises the Department of Health on how to improve them. Through his efforts we are beginning to understand, as yesterday's report illustrated, that beyond a certain basic level, it is not absolute poverty but inequality that poses the biggest threat to good health. Some very poor places - Kerala or Cuba, for instance - have better health than some rich but unequal ones. We know now that people do not only die of coronary heart disease because of a failure on the part of their local hospital. Such deaths reflect unhealthy lifestyles, and unhealthy lifestyles are often connected to poor education, bad housing, low-paid work and the low self-esteem that accompany them. The many facets of hardship take a more direct toll on vitality too. That makes closing the gap a more complex challenge than building more hospitals or training more doctors, or - as the Conservative health spokesman Andrew Lansley has been suggesting this week - telling obese people there is no excuse.

The Marmot solution is a new focus on health right across the public and private sector. If Dar es Salaam can have a healthy city programme, so can every town and village in the UK. Fair access to clean environments and clean jobs, to good housing and good schools are all part of achieving the ideal embodied in free healthcare. This government can argue that is tackling all of the above. It can be proud of the progress made in improving overall health to the extent that life expectancy for the poorest has reached the average of just eight years ago. But the wealthiest are better equipped to take up health initiatives (stopping smoking, eating more healthily), and they get healthier quicker. The gap remains.

Meeting the target of reducing it by 2010 looks a distant hope. The survival of the NHS is a symbol of the country's support for fair access to health. But unless access to the good life is shared more fairly, equal access to good health will be denied. Closing the health gap, all the evidence suggests, depends on narrowing the wealth gap.